Recognising and responding to strangulation
Non-fatal strangulation: a growing concern
In recent years, awareness of the significance of non-fatal strangulation has increased within health and justice settings. While it might seem innocuous at first glance, non-fatal strangulation can have serious consequences beyond immediate physical injury.
Immediate physical injury and silent harm
Approximately half of patients who experience strangulation show no immediate physical signs of injury. However, this deceptive lack of visible harm masks potential sequelae that can emerge later.
These sequelae include:
Carotid Dissection: Damage to the carotid arteries due to pressure on the neck.
Hypoxic Brain Injury: Reduced oxygen supply to the brain during strangulation.
Laryngeal Injury: Damage to the larynx (voice box) and surrounding structures.
Intimate partner violence and homicide risk
When an intimate partner is the perpetrator, non-fatal strangulation significantly increases the risk of homicide.
Studies indicate that victims strangled by an intimate partner face a staggering 7.48 times higher risk of being killed by that same partner.
Role of General Practitioners (GPs):
GPs play a pivotal role in addressing this issue:
Identification: Recognising signs of strangulation, even when physical injuries are not immediately apparent.
Education: Informing patients about the elevated risk of future homicide if they’ve been strangled by an intimate partner.
Treatment: Providing appropriate medical care and counselling.
Signs and symptoms
GPs should be aware of the following indicators:
Subtle Bruises or Petechiae: Tiny red or purple spots caused by broken blood vessels.
Oedema (Swelling): Swelling around the neck or face.
Focal Neurological Deficits: Abnormalities in nerve function due to compromised blood flow.
Cognitive Impairment: Changes in mental function.
Recognising these signs guides decision-making regarding referrals for further evaluation (such as imaging) and informs legal documentation.
Non-fatal strangulation is not to be underestimated. By raising awareness and educating patients, we can potentially prevent tragic outcomes.
Resources
Strangulation or suffocation fact sheet
Alliance for Hope International: Strangulation
‘I thought I was about to die’: Management of non-fatal strangulation in general practice